Feature Archive

Women, Sex, and Diabetes

Men aren't the only ones who experience sexual problems as a result of diabetes.

By Colette Bouchez
WebMD Feature

Reviewed by Louise Chang, MD

When most people hear the words "diabetes and sexual dysfunction," they automatically think it's the man's problem. But women with diabetes can also experience sexual problems related to their blood sugar levels.

For diabetes educator Ann Albright, PhD, RD, that's not only a medical fact, it's a fact of life.

Living with type 1 diabetes for 41 years, Albright says that when glucose isn't under good control, a woman's sex life can suffer.

"It's not diabetes per se that harms your intimate life. It's the complications of uncontrolled blood sugar levels that cause problems for both men and women -- the only difference is that many women simply aren't as aware of this complication as men are," she tells WebMD. Albright also is the president of health education for the American Diabetes Association.

Albright says women are getting better at coming forward with intimacy issues, but when it comes to diabetes, most are still reluctant to talk to their doctor.

Endocrinologist Loren Wissner Greene agrees. "Women aren't talking to their doctors about it, doctors aren't talking to women about it, and so for many it remains a silent problem that goes undiagnosed and untreated." Greene is a clinical associate professor at NYU Langone Medical Center in New York City.

When Glucose and Intimacy Collide

Although women with diabetes may be slow to admit there is a problem between the sheets, the medical community has been even slower to study the issue. It wasn't until 1971 that a groundbreaking study was published on this subject in the journal Diabetes.

In the study, 35% of women with diabetes reported being unable to have an orgasm during intercourse, compared to just 6% of the women who didn't have diabetes.

Albright says one reason women with diabetes may have trouble achieving orgasm is that high blood sugars can affect vaginal lubrication.

"The lubrication issues not only can impact sensation, they also can make sex very uncomfortable, even painful," she says.

In a 1986 study now considered a cornerstone of research on the topic, nearly half the women in the study had a sexual problem. Of these, 32% of women reported experiencing problems with lubrication. Eighty-nine percent said the problems started after their diabetes diagnosis.

Albright says there are many health benefits of good blood sugar control, but many women don't realize that better lubrication, and, ultimately, a better sex life may be among them.

Blood Sugar and Sexual Desire

Lubrication can be a huge intimate issue, but it's not the only one women with diabetes may have. Endocrinologist Spyros Mezitis, MD, says there are also important links between glucose levels and genital stimulation -- a factor that affects not only how pleasurable sex feels, but also a woman's desire for it.

"It all comes down to microcirculation," says Mezitis, an endocrinologist at Lenox Hill Hospital in New York City. "When blood glucose is uncontrolled, it impacts the tiny blood vessels that feed our nerves and allow a woman to experience the full spectrum of intimate sensation."

When microcirculation is impaired in men, erectile dysfunction occurs -- so the impact is obvious to both partners, he tells WebMD. In women, the effect isn't as apparent. It's all about arousal and sensation in the genital area, which frequently no one but the woman herself must acknowledge.

Greene says the longer sugar levels remain uncontrolled, the more likely it is for circulation problems to interfere with intimacy.

"Over time, increased glucose in the blood begins to destroy myelin -- a protein that covers nerves," Greene says. When this happens, it leads to neuropathy -- a type of nerve damage.

The most frequent type is peripheral neuropathy. It commonly results in foot problems such as numbness and tingling. Another type of neuropathy -- autonomic neuropathy -- affects nerves in areas such as the stomach and urinary tract and may also impact the nerves in the pelvis -- nerves that are directly connected to sexual stimulation.

"Again, it's damage to the tiny blood vessels supplying the nerves that are at the root of the problem," she says.